Sherrie
29-07-2004, 11:28 AM
Food for Thought & Feelings: Nutrition's Role in Restoring Mental Health
By Patrick Holford
How sharp is your mind? How balanced is your mood? How consistent is your energy? How happy are you? And what, if anything, do these qualities have to do with what you eat? I believe, a lot.
There has been a massive worldwide rise in the incidence of mental health problems, especially among young people. Suicide, violence and depression are on the increase, according to the World Health Organisation. Mental health problems, it says, are fast becoming the number one health issue this century, with one in ten people suffering at any point in time, and one in four people suffering at some point in their life. Having worked with thousands of people with these problems, and researched the underlying causes, I have come to the conclusion that our mind and our diet are inextricably linked.
The proof is the brain. More than any other organ in the body, it is totally dependent on a second by second supply of nutrients. It is constructed out of nutrients, communicates via neurotransmitters which are made out of nutrients and its energy source is nutrients. When you consider that the brain is entirely constructed from molecules derived from food, air and water, and that simple molecules like alcohol can fundamentally affect the brain, isn't it exceedingly unlikely that changes in diet and the environment are not affecting our mental health?
I believe that most of us are not achieving our full potential for mental health, happiness, alertness and clarity because we are not achieving optimum nutrition for the mind. I also believe that, for a significant proportion of mentally unwell people, their problems are exacerbated or even caused by a chemical imbalance brought on by years of inadequate nutrition and overexposure to pollutants and environmental toxins.
Of course, improving our mental health isn't only about nutrition. But, sadly, most psychotherapists ignore the impact of nutrition and the brain's chemistry on how we think and feel. I am convinced that the solution for the mental health problems that plague our society lies in the combination of optimum nutrition and good psychological support - which includes a place you can call home, being treated with respect, and effective counselling. One of the most limiting concepts in the human sciences is the idea that the mind and the body are separate. But it isn't just scientists who may live by this false distinction. It's us - even when we think we don't. When you are having difficulty concentrating, when your mood is low, when you struggle to find a memory, do you consider that you may be poorly nourished? Probably not, yet I wonder why. Every one of these states - thinking, feeling, mental energy and focus - happens across a network of interconnecting brain cells, each one of which depends on an optimal supply of nutrients to work efficiently. Many experiments have demonstrated this.
For instance:
• Psychologist Dr David Benton and schoolmaster Gwillym Roberts, from the Institute for Optimum Nutrition, measured the IQ scores of 90 schoolchildren and then gave 30 of them a high-dose multivitamin, 30 a dummy pill and 30 nothing at all. After eight months they re-evaluated their IQ. The children on the vitamins had a staggering increase of over 10 points in their non-verbal IQ! Since their study, published more than a decade ago, 15 other studies have confirmed that supplements boost children's IQ. The effect is real.
• Dr Thomas Crook from the Memory Assessment Clinic in Maryland, USA, gave 149 people with age-related memory impairment a daily 300mg dose of a nutrient called phosphatidyl serine. When they were tested after 12 weeks, their memory had improved to the level of those 12 years younger.
• Dr Bernard Rimland from California compared changes in the behavioural symptoms of 1591 hyperactive children treated with drugs with those of 191 hyperactive children given nutritional supplements. The nutritional approach was 18 times more effective. Yet, despite this, drug prescriptions for children almost double every year.
• Dr Carl Birmingham from the Eating Disorders Clinic in Vancouver, Canada, gave people with anorexia a zinc supplement or a placebo. Those taking zinc increased their body weight twice as rapidly as those given the dummy pills.
• Dr Abram Hoffer from Canada has treated 5000 people diagnosed with schizophrenia with high dose multinutrients, especially large doses of vitamin B3 and vitamin C. His published 40 year follow-up reports show a 90 per cent cure rate defined as free of symptoms, able to socialise with family and friends, and paying income tax. Despite this lifetime of research and results, Hoffer's approach to schizophrenia has been largely sidelined.
• Dr Poldinger and colleagues from Basle University in Switzerland gave depressed patients either a state-of-the-art SSRI antidepressant or a nutrient called 5- HTP. The nutrient outperformed the drug on every measure, resulting in greater improvements in their depression, anxiety and insomnia, and no side effects. This is in sharp contrast to the estimated daily suicide caused directly by adverse reactions to this class of antidepressant drug. .
• Bernard Gesch, director of the charity Natural Justice, gave prison inmates supplements of vitamins, minerals and essential fats, or placebos, and demonstrated a dramatic 35 per cent decrease in aggressive acts in those taking the supplements. Clearly, we can change how we think and feel by changing what we put into our mouths.
Mind and body: a self-organising jungle
As Einstein said, "The problems we have created cannot be solved at the same level of thinking we were at when we created them." We need a new way of thinking about mental health that includes the role of nutrition and the chemical environment as well as psychology, and the ways these interact to affect the way we think and feel.
Instead of the concept of trying to fix the part that doesn't work, be it the physical brain or the abstract psyche, I prefer to conceive of human beings as 'complex adaptive systems', more like a self organising jungle than a complicated computer. Of course, this adaptive capacity is not the same for all. We have different strengths and weaknesses. So, in this model, in keeping with the human givens approach, our health is a result of the interaction between our inherited adaptive capacity and our circumstances. For example, on a physical/chemical level, that would be between our genes and our environment. If our environment is sufficiently hostile (poor diet, pollution, allergens and so on), we exceed our ability to adapt and become unwell.
Our psychological 'environment' is literally everything we see, hear, smell, touch and taste - the sum total of all our sense inputs. Our psychological 'genes' are our mental constructs, our mind frame, through which we interpret whatever comes in through the senses in order to make sense of our world. We don't perceive reality as it actually is. The mental constructs are the result of our reactions to past similar experiences (pattern matching), which form the basis of our childhood conditioning. In this way we form likes and dislikes, attractions and aversions and so on.
In this model of health, there are four aspects to mental health, and four contributors to mental illness: environment (including all the nutrients and anti-nutrients we take in; genes; sense input (commonly, mental health problems develop in times of high stress, when there is more going on than a person can cope with); and mind frame.
While nutrition would seem to have little to do with our mind frame, the two are indeed related. When we cannot cope with our interpretation of reality we have to 'let off steam', to dissipate the fear, anxiety or pain; we sometimes do it by eating too much, or by consuming toxic substances such as sugar, alcohol, cigarettes or even more harmful drugs, such as heroin or cocaine. These compensating behaviours leave us drained of both energy and nutrients, making matters worse. To cope with the tiredness we may then use stimulants, which further deplete us, leading to more and more addiction, and worsening mental health. It is a vicious downward spiral.
The holistic approach
Sometimes, the nutritional problems precede the psychological ones. Peter has blood sugar problems, is lacking B vitamins and has 'reward deficiency syndrome' - a genetic predisposition to under-producing dopamine, the 'motivating' neurotransmitter. All of these factors make him tired and unmotivated. He therefore craves stimulation and stimulants, such as sugar and caffeine, to make him feel good. Unfortunately, these make him more mentally hyperactive, and he can't switch off his thoughts. So he starts drinking alcohol every day. This makes him more depressed. His doctor prescribes antidepressants. Nothing gets better. His wife leaves him and he loses his job. He feels useless, worthless and hopelessly inadequate. He can't cope with what is happening in his life and escapes into his own world. He has a breakdown. He is prescribed major tranquillisers, which make him seem more stable, but he is still mentally ill.
Peter's problems show the complex interplay between genes, environment, sense input and mind frame. Drugs alone will not restore Peter's health. He needs to rebalance his brain's chemistry with optimum nutrition, and rebalance his psyche with good psychological guidance and support. Most of all, he needs the willingness to change his diet, his lifestyle and his mind frame. This total approach is likely to be much more effective than just drugs, psychotherapy or nutritional therapy alone.
Depression: another way of looking
I now plan to look in detail at the impact of good nutrition on depression. Most people taking antidepressants really need to deal with something that isn't working in their life. However, one of the greatest unrecognised truths is that ensuring optimum nutrition for the mind not only improves mood but gives a person the energy and motivation to make those changes. Few psychotherapists recognise how much better their results might be if they helped their clients tune up their brain biochemistry through improved nutrition.
These are the common imbalances connected to nutrition that can worsen mood and motivation:
• blood sugar imbalances (often associated with excessive sugar and stimulant intake)
• deficiencies of nutrients (vitamin B3, B6, folate, B12, C, zinc, magnesium, essential fatty acids)
• deficiencies of tryptophan and tyrosine (precursors of neurotransmitters)
• allergies and sensitivities.
One factor that underlies most depression is poor control of blood glucose levels. Keeping blood sugar levels more even can be achieved by eating small regular meals of natural, unprocessed foods, including protein and fibre, and taking a combination ofB vitamins and chromium.
The most promising nutrients for improving mood are vitamins B3, B12 and folic acid, then vitamin B6, zinc, magnesium and essential fatty acids (EFAs). The first three are involved in the vital biochemical process known as methylation, which is critical for balancing the neurotransmitters dopamine and adrenalin. A study at King's College Hospital in London found that giving folic acid supplements to people with borderline or low folic acid levels alongside standard drug treatment significantly improved recovery in patients with depression. Their research found that a third of all people with depression and other psychiatric disorders were deficient in folic acid. Giving vitamin C has also been shown to enhance recovery.
Why women are more depressed
There are often two sides to feeling blue - feeling miserable, and feeling apathetic and unmotivated. The most prevalent biochemical theory for the cause is a brain imbalance in two families of neurotransmitters - the molecules of emotion. These are serotonin, which influences mood, and adrenalin and noradrenalin, made from dopamine, which influence motivation.
Women are three times as prone to low moods as men. Many theories as to why have been proposed, some psychological, some social. However, women and men are biochemically very different, as the research of Mirko Diksic and colleagues at McGill University in Montreal has demonstrated. They developed a technique using PET neuroimaging to measure the rate at which we make serotonin in the brain and found that men's average synthesis rate of serotonin is 52 per cent higher than women's. This, and other research, has clearly shown that women are more prone to low serotonin.
The serotonin story
It has been learned in the last few years that there are six main reasons for deficiency in serotonin (in addition to a lack of the amino acid that makes it): not enough oestrogen (in women); not enough testosterone (in men); not enough light; not enough exercise; too much stress, especially in women; not enough co-factor vitamins and minerals.
If people are suffering from low mood, feel tense and irritable, are low in energy, tend to comfort eat, have sleeping problems and a reduced interest in sex, and any of the above six main reasons for deficiency, the chances are they are short on serotonin.
Low oestrogen means low serotonin and low moods. because oestrogen blocks the breakdown of serotonin. This may largely explain why women are more prone to depression premenstrually and in the menopause and thereafter. Low testosterone has a similar effect in men.
Light stimulates oestrogen, and most of us don't get enough of it. The difference in light exposure outside and inside is massive. Most of us spend 23 out of 24 hours a day indoors, exposed to an average of 100 units (called lux) of light. That's compared to 20,000 lux on a sunny day and 7000 lux on an overcast day. Now, more than ever before, many of us rarely expose ourselves to direct sunlight, and certainly not enough to maximise serotonin production. Of course, light deficiency is worse in the winter.
Stress also rapidly reduces serotonin levels. Physical exercise improves stress response, and therefore reduces stress-induced depletion of serotonin.
Diet for depression
A safer alternative to antidepressant drugs like Prozac (which stop the body breaking down serotonin, therefore keeping more circulating in the brain) would be to eat foods from which the body makes serotonin.
Serotonin is made from a conatituent of protein, the amino acid tryptophan. Supplementing the amino acid tryptophan is already well proven to improve mood. Donald Ecclestone, professor of medicine at the Royal Victoria Infirmary in Newcastle, reviewed the available studies and concluded that supplementing tryptophan leads to an increase in the synthesis of serotonin in the brain, improving mood.
Even more effective is a derivative of tryptophan that is one step closer to serotonin. This is called 5-hydroxytryptophan, or 5-HTP for short, and is derived from an African plant called griffonia. The first study proving the mood-boosting power of 5HTP was done in the 1970s in Japan, under the direction of Professor Isamu Sano of the Osaka University Medical School. He gave 107 depressed patients 50-300 mg of 5-HTP per day and, within two weeks, more than half experienced improvements in their symptoms. By the end of the four week study, nearly three quarters of the patients reported either complete relief or significant improvement, with no side effects. This study was repeated by other researchers who found that 69 per cent of patients improved their mood.
Since then, studies have shown that this nutrient is as effective as the best antidepressants with a traction, if any, of the side-effects. One double-blind trial headed by Dr Poldinger at the Basle University of Psychiatry gave 34 depressed volunteers either the SSRI antidepressant fluvoxamine, or 300mg of 5-HTP. Each patient was assessed for their degree of depression using the widely accepted Hamilton Rating Scale, plus their own subjective self assessment. At the end of the six weeks, both groups of patient had had a significant improvement in their depression. However, those taking 5-HTP had a greater improvement in each of the four criteria assessed - depression, anxiety, insomnia and physical symptoms - as well as in self assessment.6
The brain friendly diet
• Wholefoods - wholegrains (such as rice, millet, rye, oats, wholewheat, corn or quinoa as cereal, breads and pasta), lentils, beans, nuts, seeds, fresh fruit and vegetables
• Cold-water carnivorous fish - herring, . mackerel, salmon or fresh tuna
• Eggs - preferably free-range and organic
• Cold-pressed seed oils
Given that 5-HTP is less expensive and has significantly fewer side effects, it is extraordinary that psychiatrists, despite plenty of scientific evidence that it helps restore normal mood and normal serotonin levels, almost never prescribe it. The recommended dosage of this natural supplement, available in any health food shop, is 100 mg of 5HTP, twice a day, for depression. Some supplements also provide various vitamins and minerals such as vitamin B3, B6 and folic acid, which may be even more effective because these nutrients help to turn 5-HTP into serotonin.
A new understanding of apathy
Deficiency in the neurotransmitter adrenalin, and its brother, noradrenalin, is, as mentioned, also associated with depression, and lack of motivation. They are made from dopamine, which is made from the amino acid tyrosine, which is made from the amino acid phenylalanine. If drugs that block the breakdown of these neurotransmitters elevate mood, then supplementing the amino acid phenylalanine or tyrosine might work too, without the side effects. And they do.
In a double-blind study by Helmut Beckmann and colleagues at the University of Wurzburg in Germany, 150-200 mg of the amino acid phenylalanine or the antidepressant drug imipramine were administered to 40 depressed patients for one month. Both groups had similar positive results less depression, anxiety and sleep disturbance.
The military has long known that tyrosine improves mental and physical performance under stress. Recent research from the Netherlands demonstrates how tyrosine gives an edge in conditions of stress. Twenty-one cadets were put through a demanding one week military combat training course. Ten cadets were given a drink containing 2g of tyrosine a day, while the remaining 11 were given an identical drink without the tyrosine. Those on tyrosine consistently performed better, both in memorising the task at hand and in tracking the tasks they had performed. The best results of all are achieved by supplementing all of these amino acids - 5-HTP, phenylalanine and tyrosine - together with the B vitamins B3, B6, B12 and folic acid, which helps turn them into neurotransmitters.
The master tuners
TMG (tri-methyl-glycine) and SAMe (s-adenosyl methionine) are also types of amino acids. They help to keep the brain and nervous system well tuned and, together with B vitamins, can make all the difference. SAMe is one of the most comprehensively studied natural antidepressants. Over a hundred placebo-controlled, double-blind studies show it is equal or superior to antidepressants, works faster, most often within a few days (most pharmaceutical antidepressants may take three to six weeks to take effect) and with few side-effects. Between 200 and 600 mg a day is required but it is both very expensive and very unstable- a lot of SAMe sold in health food shops is pretty ineffective. TMG is much more stable and less costly. In the body it turns into SAMe, but three times as much needs to be supplemented. I recommend 600 to 2000 mg a day, on an empty stomach or with fruit.
Mood-boosting fats
Omega-3 fish oils are very much part of my equation for happiness. The higher the blood levels of omega-3 fats, the higher the levels of serotonin are likely to be. This is because omega-3 fats help build receptor sites, as well as improving reception. According to Dr J R Hibbeln, who discovered that fish eaters are less prone to depression, "It's like building more serotonin factories, instead of just increasing the efficiency of the serotonin you have". A recent trial published in the American Journal of Psychiatry tested the effects of giving 20 people (already on antidepressants but still depressed) a highly concentrated form of omega-3 fat called ethyl-EPA. By the third week, the depressed patients were showing major improvement in their mood, while those on placebo were not.
Working wonders
The combination of the 'optimum nutrition' approach and effective psychotherapy works wonders for a wide variety of mental health problems, from depression to schizophrenia. Most of the psychiatrists I work with find that, while drugs can sometimes be life saving in the short term, they become unnecessary with the right combination of nutrients and psychological counselling and support. The need for essential nutrients is a human given, which, in our modern age of intensive farming, fast food and so on, has become less easy to fulfil. Helping people find ways to meet their need for essential nutrition, alongside helping them understand and meet their emotional needs, should form the basis of an enlightened approach to mental health
By Patrick Holford
How sharp is your mind? How balanced is your mood? How consistent is your energy? How happy are you? And what, if anything, do these qualities have to do with what you eat? I believe, a lot.
There has been a massive worldwide rise in the incidence of mental health problems, especially among young people. Suicide, violence and depression are on the increase, according to the World Health Organisation. Mental health problems, it says, are fast becoming the number one health issue this century, with one in ten people suffering at any point in time, and one in four people suffering at some point in their life. Having worked with thousands of people with these problems, and researched the underlying causes, I have come to the conclusion that our mind and our diet are inextricably linked.
The proof is the brain. More than any other organ in the body, it is totally dependent on a second by second supply of nutrients. It is constructed out of nutrients, communicates via neurotransmitters which are made out of nutrients and its energy source is nutrients. When you consider that the brain is entirely constructed from molecules derived from food, air and water, and that simple molecules like alcohol can fundamentally affect the brain, isn't it exceedingly unlikely that changes in diet and the environment are not affecting our mental health?
I believe that most of us are not achieving our full potential for mental health, happiness, alertness and clarity because we are not achieving optimum nutrition for the mind. I also believe that, for a significant proportion of mentally unwell people, their problems are exacerbated or even caused by a chemical imbalance brought on by years of inadequate nutrition and overexposure to pollutants and environmental toxins.
Of course, improving our mental health isn't only about nutrition. But, sadly, most psychotherapists ignore the impact of nutrition and the brain's chemistry on how we think and feel. I am convinced that the solution for the mental health problems that plague our society lies in the combination of optimum nutrition and good psychological support - which includes a place you can call home, being treated with respect, and effective counselling. One of the most limiting concepts in the human sciences is the idea that the mind and the body are separate. But it isn't just scientists who may live by this false distinction. It's us - even when we think we don't. When you are having difficulty concentrating, when your mood is low, when you struggle to find a memory, do you consider that you may be poorly nourished? Probably not, yet I wonder why. Every one of these states - thinking, feeling, mental energy and focus - happens across a network of interconnecting brain cells, each one of which depends on an optimal supply of nutrients to work efficiently. Many experiments have demonstrated this.
For instance:
• Psychologist Dr David Benton and schoolmaster Gwillym Roberts, from the Institute for Optimum Nutrition, measured the IQ scores of 90 schoolchildren and then gave 30 of them a high-dose multivitamin, 30 a dummy pill and 30 nothing at all. After eight months they re-evaluated their IQ. The children on the vitamins had a staggering increase of over 10 points in their non-verbal IQ! Since their study, published more than a decade ago, 15 other studies have confirmed that supplements boost children's IQ. The effect is real.
• Dr Thomas Crook from the Memory Assessment Clinic in Maryland, USA, gave 149 people with age-related memory impairment a daily 300mg dose of a nutrient called phosphatidyl serine. When they were tested after 12 weeks, their memory had improved to the level of those 12 years younger.
• Dr Bernard Rimland from California compared changes in the behavioural symptoms of 1591 hyperactive children treated with drugs with those of 191 hyperactive children given nutritional supplements. The nutritional approach was 18 times more effective. Yet, despite this, drug prescriptions for children almost double every year.
• Dr Carl Birmingham from the Eating Disorders Clinic in Vancouver, Canada, gave people with anorexia a zinc supplement or a placebo. Those taking zinc increased their body weight twice as rapidly as those given the dummy pills.
• Dr Abram Hoffer from Canada has treated 5000 people diagnosed with schizophrenia with high dose multinutrients, especially large doses of vitamin B3 and vitamin C. His published 40 year follow-up reports show a 90 per cent cure rate defined as free of symptoms, able to socialise with family and friends, and paying income tax. Despite this lifetime of research and results, Hoffer's approach to schizophrenia has been largely sidelined.
• Dr Poldinger and colleagues from Basle University in Switzerland gave depressed patients either a state-of-the-art SSRI antidepressant or a nutrient called 5- HTP. The nutrient outperformed the drug on every measure, resulting in greater improvements in their depression, anxiety and insomnia, and no side effects. This is in sharp contrast to the estimated daily suicide caused directly by adverse reactions to this class of antidepressant drug. .
• Bernard Gesch, director of the charity Natural Justice, gave prison inmates supplements of vitamins, minerals and essential fats, or placebos, and demonstrated a dramatic 35 per cent decrease in aggressive acts in those taking the supplements. Clearly, we can change how we think and feel by changing what we put into our mouths.
Mind and body: a self-organising jungle
As Einstein said, "The problems we have created cannot be solved at the same level of thinking we were at when we created them." We need a new way of thinking about mental health that includes the role of nutrition and the chemical environment as well as psychology, and the ways these interact to affect the way we think and feel.
Instead of the concept of trying to fix the part that doesn't work, be it the physical brain or the abstract psyche, I prefer to conceive of human beings as 'complex adaptive systems', more like a self organising jungle than a complicated computer. Of course, this adaptive capacity is not the same for all. We have different strengths and weaknesses. So, in this model, in keeping with the human givens approach, our health is a result of the interaction between our inherited adaptive capacity and our circumstances. For example, on a physical/chemical level, that would be between our genes and our environment. If our environment is sufficiently hostile (poor diet, pollution, allergens and so on), we exceed our ability to adapt and become unwell.
Our psychological 'environment' is literally everything we see, hear, smell, touch and taste - the sum total of all our sense inputs. Our psychological 'genes' are our mental constructs, our mind frame, through which we interpret whatever comes in through the senses in order to make sense of our world. We don't perceive reality as it actually is. The mental constructs are the result of our reactions to past similar experiences (pattern matching), which form the basis of our childhood conditioning. In this way we form likes and dislikes, attractions and aversions and so on.
In this model of health, there are four aspects to mental health, and four contributors to mental illness: environment (including all the nutrients and anti-nutrients we take in; genes; sense input (commonly, mental health problems develop in times of high stress, when there is more going on than a person can cope with); and mind frame.
While nutrition would seem to have little to do with our mind frame, the two are indeed related. When we cannot cope with our interpretation of reality we have to 'let off steam', to dissipate the fear, anxiety or pain; we sometimes do it by eating too much, or by consuming toxic substances such as sugar, alcohol, cigarettes or even more harmful drugs, such as heroin or cocaine. These compensating behaviours leave us drained of both energy and nutrients, making matters worse. To cope with the tiredness we may then use stimulants, which further deplete us, leading to more and more addiction, and worsening mental health. It is a vicious downward spiral.
The holistic approach
Sometimes, the nutritional problems precede the psychological ones. Peter has blood sugar problems, is lacking B vitamins and has 'reward deficiency syndrome' - a genetic predisposition to under-producing dopamine, the 'motivating' neurotransmitter. All of these factors make him tired and unmotivated. He therefore craves stimulation and stimulants, such as sugar and caffeine, to make him feel good. Unfortunately, these make him more mentally hyperactive, and he can't switch off his thoughts. So he starts drinking alcohol every day. This makes him more depressed. His doctor prescribes antidepressants. Nothing gets better. His wife leaves him and he loses his job. He feels useless, worthless and hopelessly inadequate. He can't cope with what is happening in his life and escapes into his own world. He has a breakdown. He is prescribed major tranquillisers, which make him seem more stable, but he is still mentally ill.
Peter's problems show the complex interplay between genes, environment, sense input and mind frame. Drugs alone will not restore Peter's health. He needs to rebalance his brain's chemistry with optimum nutrition, and rebalance his psyche with good psychological guidance and support. Most of all, he needs the willingness to change his diet, his lifestyle and his mind frame. This total approach is likely to be much more effective than just drugs, psychotherapy or nutritional therapy alone.
Depression: another way of looking
I now plan to look in detail at the impact of good nutrition on depression. Most people taking antidepressants really need to deal with something that isn't working in their life. However, one of the greatest unrecognised truths is that ensuring optimum nutrition for the mind not only improves mood but gives a person the energy and motivation to make those changes. Few psychotherapists recognise how much better their results might be if they helped their clients tune up their brain biochemistry through improved nutrition.
These are the common imbalances connected to nutrition that can worsen mood and motivation:
• blood sugar imbalances (often associated with excessive sugar and stimulant intake)
• deficiencies of nutrients (vitamin B3, B6, folate, B12, C, zinc, magnesium, essential fatty acids)
• deficiencies of tryptophan and tyrosine (precursors of neurotransmitters)
• allergies and sensitivities.
One factor that underlies most depression is poor control of blood glucose levels. Keeping blood sugar levels more even can be achieved by eating small regular meals of natural, unprocessed foods, including protein and fibre, and taking a combination ofB vitamins and chromium.
The most promising nutrients for improving mood are vitamins B3, B12 and folic acid, then vitamin B6, zinc, magnesium and essential fatty acids (EFAs). The first three are involved in the vital biochemical process known as methylation, which is critical for balancing the neurotransmitters dopamine and adrenalin. A study at King's College Hospital in London found that giving folic acid supplements to people with borderline or low folic acid levels alongside standard drug treatment significantly improved recovery in patients with depression. Their research found that a third of all people with depression and other psychiatric disorders were deficient in folic acid. Giving vitamin C has also been shown to enhance recovery.
Why women are more depressed
There are often two sides to feeling blue - feeling miserable, and feeling apathetic and unmotivated. The most prevalent biochemical theory for the cause is a brain imbalance in two families of neurotransmitters - the molecules of emotion. These are serotonin, which influences mood, and adrenalin and noradrenalin, made from dopamine, which influence motivation.
Women are three times as prone to low moods as men. Many theories as to why have been proposed, some psychological, some social. However, women and men are biochemically very different, as the research of Mirko Diksic and colleagues at McGill University in Montreal has demonstrated. They developed a technique using PET neuroimaging to measure the rate at which we make serotonin in the brain and found that men's average synthesis rate of serotonin is 52 per cent higher than women's. This, and other research, has clearly shown that women are more prone to low serotonin.
The serotonin story
It has been learned in the last few years that there are six main reasons for deficiency in serotonin (in addition to a lack of the amino acid that makes it): not enough oestrogen (in women); not enough testosterone (in men); not enough light; not enough exercise; too much stress, especially in women; not enough co-factor vitamins and minerals.
If people are suffering from low mood, feel tense and irritable, are low in energy, tend to comfort eat, have sleeping problems and a reduced interest in sex, and any of the above six main reasons for deficiency, the chances are they are short on serotonin.
Low oestrogen means low serotonin and low moods. because oestrogen blocks the breakdown of serotonin. This may largely explain why women are more prone to depression premenstrually and in the menopause and thereafter. Low testosterone has a similar effect in men.
Light stimulates oestrogen, and most of us don't get enough of it. The difference in light exposure outside and inside is massive. Most of us spend 23 out of 24 hours a day indoors, exposed to an average of 100 units (called lux) of light. That's compared to 20,000 lux on a sunny day and 7000 lux on an overcast day. Now, more than ever before, many of us rarely expose ourselves to direct sunlight, and certainly not enough to maximise serotonin production. Of course, light deficiency is worse in the winter.
Stress also rapidly reduces serotonin levels. Physical exercise improves stress response, and therefore reduces stress-induced depletion of serotonin.
Diet for depression
A safer alternative to antidepressant drugs like Prozac (which stop the body breaking down serotonin, therefore keeping more circulating in the brain) would be to eat foods from which the body makes serotonin.
Serotonin is made from a conatituent of protein, the amino acid tryptophan. Supplementing the amino acid tryptophan is already well proven to improve mood. Donald Ecclestone, professor of medicine at the Royal Victoria Infirmary in Newcastle, reviewed the available studies and concluded that supplementing tryptophan leads to an increase in the synthesis of serotonin in the brain, improving mood.
Even more effective is a derivative of tryptophan that is one step closer to serotonin. This is called 5-hydroxytryptophan, or 5-HTP for short, and is derived from an African plant called griffonia. The first study proving the mood-boosting power of 5HTP was done in the 1970s in Japan, under the direction of Professor Isamu Sano of the Osaka University Medical School. He gave 107 depressed patients 50-300 mg of 5-HTP per day and, within two weeks, more than half experienced improvements in their symptoms. By the end of the four week study, nearly three quarters of the patients reported either complete relief or significant improvement, with no side effects. This study was repeated by other researchers who found that 69 per cent of patients improved their mood.
Since then, studies have shown that this nutrient is as effective as the best antidepressants with a traction, if any, of the side-effects. One double-blind trial headed by Dr Poldinger at the Basle University of Psychiatry gave 34 depressed volunteers either the SSRI antidepressant fluvoxamine, or 300mg of 5-HTP. Each patient was assessed for their degree of depression using the widely accepted Hamilton Rating Scale, plus their own subjective self assessment. At the end of the six weeks, both groups of patient had had a significant improvement in their depression. However, those taking 5-HTP had a greater improvement in each of the four criteria assessed - depression, anxiety, insomnia and physical symptoms - as well as in self assessment.6
The brain friendly diet
• Wholefoods - wholegrains (such as rice, millet, rye, oats, wholewheat, corn or quinoa as cereal, breads and pasta), lentils, beans, nuts, seeds, fresh fruit and vegetables
• Cold-water carnivorous fish - herring, . mackerel, salmon or fresh tuna
• Eggs - preferably free-range and organic
• Cold-pressed seed oils
Given that 5-HTP is less expensive and has significantly fewer side effects, it is extraordinary that psychiatrists, despite plenty of scientific evidence that it helps restore normal mood and normal serotonin levels, almost never prescribe it. The recommended dosage of this natural supplement, available in any health food shop, is 100 mg of 5HTP, twice a day, for depression. Some supplements also provide various vitamins and minerals such as vitamin B3, B6 and folic acid, which may be even more effective because these nutrients help to turn 5-HTP into serotonin.
A new understanding of apathy
Deficiency in the neurotransmitter adrenalin, and its brother, noradrenalin, is, as mentioned, also associated with depression, and lack of motivation. They are made from dopamine, which is made from the amino acid tyrosine, which is made from the amino acid phenylalanine. If drugs that block the breakdown of these neurotransmitters elevate mood, then supplementing the amino acid phenylalanine or tyrosine might work too, without the side effects. And they do.
In a double-blind study by Helmut Beckmann and colleagues at the University of Wurzburg in Germany, 150-200 mg of the amino acid phenylalanine or the antidepressant drug imipramine were administered to 40 depressed patients for one month. Both groups had similar positive results less depression, anxiety and sleep disturbance.
The military has long known that tyrosine improves mental and physical performance under stress. Recent research from the Netherlands demonstrates how tyrosine gives an edge in conditions of stress. Twenty-one cadets were put through a demanding one week military combat training course. Ten cadets were given a drink containing 2g of tyrosine a day, while the remaining 11 were given an identical drink without the tyrosine. Those on tyrosine consistently performed better, both in memorising the task at hand and in tracking the tasks they had performed. The best results of all are achieved by supplementing all of these amino acids - 5-HTP, phenylalanine and tyrosine - together with the B vitamins B3, B6, B12 and folic acid, which helps turn them into neurotransmitters.
The master tuners
TMG (tri-methyl-glycine) and SAMe (s-adenosyl methionine) are also types of amino acids. They help to keep the brain and nervous system well tuned and, together with B vitamins, can make all the difference. SAMe is one of the most comprehensively studied natural antidepressants. Over a hundred placebo-controlled, double-blind studies show it is equal or superior to antidepressants, works faster, most often within a few days (most pharmaceutical antidepressants may take three to six weeks to take effect) and with few side-effects. Between 200 and 600 mg a day is required but it is both very expensive and very unstable- a lot of SAMe sold in health food shops is pretty ineffective. TMG is much more stable and less costly. In the body it turns into SAMe, but three times as much needs to be supplemented. I recommend 600 to 2000 mg a day, on an empty stomach or with fruit.
Mood-boosting fats
Omega-3 fish oils are very much part of my equation for happiness. The higher the blood levels of omega-3 fats, the higher the levels of serotonin are likely to be. This is because omega-3 fats help build receptor sites, as well as improving reception. According to Dr J R Hibbeln, who discovered that fish eaters are less prone to depression, "It's like building more serotonin factories, instead of just increasing the efficiency of the serotonin you have". A recent trial published in the American Journal of Psychiatry tested the effects of giving 20 people (already on antidepressants but still depressed) a highly concentrated form of omega-3 fat called ethyl-EPA. By the third week, the depressed patients were showing major improvement in their mood, while those on placebo were not.
Working wonders
The combination of the 'optimum nutrition' approach and effective psychotherapy works wonders for a wide variety of mental health problems, from depression to schizophrenia. Most of the psychiatrists I work with find that, while drugs can sometimes be life saving in the short term, they become unnecessary with the right combination of nutrients and psychological counselling and support. The need for essential nutrients is a human given, which, in our modern age of intensive farming, fast food and so on, has become less easy to fulfil. Helping people find ways to meet their need for essential nutrition, alongside helping them understand and meet their emotional needs, should form the basis of an enlightened approach to mental health